Book reviews

Democracy and military dictatorships alternate game each other on the political scene of Pakistan, almost playing a same of hide and seek. Pakistani politics and Pakistan Army cannot be separated from each other as military have remained in power for more than half of Pakistan’s existence. Therefore any book on the Pakistani military ostensibly has to devote some portion to the role played by the armed forces in the politics of Pakistan. The book under consideration is no exception. What distinguishes this book from other works on Pakistan’s military is that other works have devoted a chapter on the military’s role in politics separately. This book on the other hand travels through a historical frame by discussing military adventures, wars and the military’s peace-time activities along with the politics and process of governance.


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Critical Analysis. these charges, we ean only urge, that the gravity of our language appears to us best suited to the importance of our subjects ; and, that, having been all of us early in life somewhat roughly treated, we may feel a degree of sympathy for our writing brethren. A charge is now made against us which we least of ali expected, but for which we are ready to express our gratitude, as our utmost wish is to preserve a faithful register of every medical event. As soon, therefore, as we learned that objections were made against the remarks on Dr. Philips' paper, contained in our last number, those objections were instantly conveyed to the gentleman ?who honoured us with the article, with a request that he would either defend himself, or instruct us all in what manner we might confess our errors with the best grace. We have received the following answer, which we transcribe in his own words :? GENTLEMEN, I am fully aware of your instructions, le on all occasions to observe the strictest impartiality, to be careful that every remark shall be couched in gentlemanly terms, and that the true spirit and intent of every work shall be entered into and explained in as few words as are consistent with perspicuity." In all this it has been my endeavour to fulfil your wishes; and, upon perusing the article to which you refer me, I am obliged to admit two of the charges, namely, ignorance of Dr. Philips' intention, and an appearance of sarcasm in some of my expressions. The first, I hope, is venial, if not from the obscurity of the subject, at least from my confession: of the second I was not aware at the time, but, on a re-perusal, am forced to admit that some passages will bear such an implication.
It now becomes me to clear myself from wilful misjtepresention.
The first charge is, that I have taken no notice of Dr. P.'s former paper, though connected with that under consideration.
2(ily, That I require respiration should be attended to in whatever relates to the actions of the heart, though the experiments in the last paper are unconnected with that process* 3dly, That my account of another experiment is unintelligible, because 1 speak of the extremities of the nerves when mentioning experiments on the brain.
The other charges shall be transcribed at length. ,As to the first objection, I conceive the paper has been already noticed in your Journal, i, however, made it my business to peruse it, and fancied that in this, as in most of ' the Defence of the Review of Dr. Philips* Paper. 317 the French experimental physiology, one great error prevailed in not distinguishing between death and a cessation of action. Without repeating the disgusting cruelties of hot wires applied to the spinal marrow of various incisions, ligatures, &c. and contrasting them with the more tender manner of knocking at head, 01* suddenly and violently injuring the spinal marrow, these gentlemen should be taught, that, by a slow mode of killing an animal, life may be for some time retained in the various parts, which may, therefore, be affected by stimuli immediately applied to them: but by a violent blow, not only in an animal so easily killed as a rabbit, but even in the vivacious eel, absolute universal death* is often induced, either instantly, in which case the muscles will never contract, that is, stiffening will never take place,?or they will contract so suddenly, that is, stiffening, or, as Dr. P. calls it, a spasm on the muscles, will instantly follow, and be almost as suddenly succeeded byuniversal death, or a relaxation of the muscles never to be again stimulated. An attention to this single circumstance explains ail the difficulties in Haller and in Gallois, without the necessity of any one of Dr. Philips' numerous experiments, or the philosophic candour with which he wishes to treat the French physiologist.
Secondly, in attending to a description of the actions in the heart and arteries of stunned or decapitated animals, the reader can scarcely fail to inquire whether respiration continued in the first, or was artificially maintained in the second. Thirdly, Such physiologists as still conceive that the nerves originate from the brain, may continue^to adopt the term, origin of a nerve for its superior extremity ; and, in common language, this may be of less consequence, but in philosophical controversy it appeared to me more correct to usa the term extremity; and you may perceive by the context that there can be no possibility of doubting which extremity" is intended.
You will now give me leave to transcribe from the journal you have done me the honour to send me the following words of my antagonist. Hunter, 4 docs not arise from an immediate impulse on the brain, as it does in the voluntary muscles.' This is a peculiarly unfortunate quotation; the result of Dr. Philips' experiments being -ex-> actly the reverse of Mr. Hunter's assertion. It appears from them that the heart's motion often does arise from an immediate impulse SI8 Critical Analysis. on the brain. No man has a greater respect, I may say veneration, for Mr, Hunter, than the writer of this paper ; but I feel no hesitation in affirming, that the works of this great physiologist contain no anticipation of the views afforded by Dr. Philips' expe.

riments."
This respect and veneration for Mr. Hunter may be very great, but I trust some of your readers will think it much lessened when it is more than hinted that so respectable, so venerable a name, is to be eclipsed by Dr. Philips'. Let us examine, then, the passage, and see whether the compliment I wished to pay Dr. Philips in confirming his accuracy by the authority of Mr. Hunter is not well founded.
Mr, Hunter says, " the heart's motion does not arise [or originate] from any immediate impulse on the brain." l)r. Philips shows " that the power of the heart is independant of the nervous system." That its ordinary motion may be accelerated by stimuli applied to the brain, or to any part of the body, did not require an experiment for its proof.
This will be further explained in my remarks on the follow-* ing extract. The words of my antagonist are?
il He then observes, ' Some remarks follow on the effect of communicating sensation,'?motion, he should have said,?by th& nervous ganglia. In these there is nothing new.' The points on this subject, ascertained by the experience of Dr. Philips, are, that the heart obeys stimuli applied to every part of the brain and spinal marrow ; and, consequently, that nerves issuing from garU glia, the only nerves which the heart receives, convey the influence of every part of these organs, while those parts of the body not supplied with nerves from ganglia obey only the minute parts of the nervous system from which their nerves arise. Now, either the reviewer knows of some work not known to the public, in winch Dr. Philips has been anticipated in this discovery, or he has here slated what he cannot confirm." I am much obliged to this gentleman for setting me right in substituting the word motion for sensation: perhaps we are both wrong, and, instead of altering the noun, it might be better to alter the verb, using exciting instead of commit* nicating. It will then be seen, that, as the motion could onlv follow the sensation, it is of less consequence which term is used. It may serve, however, to puzzle, if that were; necessary ; but to me the remainder of the paragraph is puzzling enough of itself.
You will not, I am sure, accuse me of inattention to the events passing in the medical world, nor, I trust, doubt the truth of my assertion, that Dr. P.'s paper occupied more of my time and application than all the other works which arrived by Aledico-Chirurgical Transactions. 319 by the same packet. If his experiments (I am not speaking of his inferences) really show, or even imply, that the distribution of nerves in the heart is different from that in the rest of the body, or even if they showed any thing in this respect different from what was generally known, 1 confess it escaped, and still does escape, my notice. If they only showed that the ^ heart sympathizes with every part of the brain, without the necessity of the will, whilst the involuntary muscles only sympathize with the brain according to the directions of the will,?all this, I conceive, is contained in Mr. Hunter's remark, to which 1 referred your readers, " that the motion of the heart, that is, its regular alternate contraction and relaxation, does not arise from any impulse on the brain, like the voluntary actions of the muscles usually termed voluntary." After very long study, however, I am somewhat doubtful whether Dr. Philips and his encomiast may not mean more than occurred to me before. The heart is supplied with nerves only from the ganglia, and is affected by stimuli applied to every part of the brain and spinal marrow: ergo, nerves issuing from ganglia convey the influence of every part of the brain and spinal marrow ; while those parts whose nerves do not issue from ganglia are only affected by stimuli applied to parts of the brain and spinal marrow immediately contiguous to that part of the brain or spinal marrow from ?which they issue. If this is his meaning, more experiments are required. The muscles of the abdomen, and the intercostal muscles, receive their nerves from ganglia. Are these also affected by stimuli applied to every part of the brain and spinal marrow ? Such, gentlemen, is my defence. I will not, however, assert that Dr. IVs experiments throw no light on pathology?
They may lead us to some important conclusions concerning convulsions, which may be improved by those who draw proper inferences. I sincerely hope, therefore, that Dr. P. will continue his experiments, with less cruelty ; and in future I shall relieve myself from too close an attention to his inferences, conceiving it enough to admit the faithfulness of his reports. I haye the honour to be, a subject connected with the doctrine of contagion, we shall give as copious extracts, and with as many remarks, as our limits will permit. The paper begins in a manner which arrests our particular attention to these subjects. " The following communication has two objects in -view: first, to give a faithful narrative of the introduction and progress of the plague at Malta, in the year 1813; and, secondly, to ascertain, from induction of facts, the laws of pestilenlial contagion, so as to direct us in the employment of preservative means; but particularly as relates to the construction of lazarets, and to the ad. mission of people known to be infected within our ports. t" Towards the accomplishment of these two ends, the most prominent circumstances that occurred during the pestilential season are selected, while the principal proclamations and other public documents are given without comment, that the facts themselves may be seen without the colouring which they might receive from argument." ? I do not believe, (concludes Dr. C. in this introductory part,) as it will be seen, that the plague found its way into the island and spread itself from want of exertion on the part of government, or of the department of health; for almost every human means were put in force in conformity with the popular doctrine of pestilential contagion; but the grand and fundamental error, I believe, was wholly and solely in the doctrine itself.'* The rest of the paper occupies sixty pages: Ave can, therefore, only admit an abstract of the historical part.
The following is the history of the vessel and crew which are supposed to have introduced the pestilential contagion into Malta: S21 "As the crew consisted of men of different nations, they were divided into companies accordingly, each company being provided with two apartments in the lazaret; and, as the captain and his servant were both Maltese, they lived together.
"The whole continued, in appearance, to enjoy the most perfect health till the 1st of April, when, on the afternoon of that day, the captain, while playing at ball, was suddenly seized with head, ach, giddiness, and other symptoms of plague; and he died in the course of about thirty-six hours. His servant, who had also assisted the sick men on board, was seized about the same time with similar symptoms, and he died after a like interval. They were both buried in the lazaret.
" While these things occurred on shore, the usual precautions with regard to the ship were not neglected. She had remained in the middle of the quarantine harbour from the time of her arrival, with two guard-boats stationed near her, to prevent every kind of communication; and she continued in this situation near a fortnight, at the end of which time a number of men were hired, for a considerable sum, to conduct her back to Alexandria. " The ship and the whole of these men arrived safe in Alexandria, and the cargo was afterwards taken out without a single individual being infected, as appears by the following letters from the British consul at that place, addressed to Lieutenant-general Oaks, the King's commissioner at Malta.
(Translation, No. 1.) tl 1 May it please your Excellency, { It is with the greatest satisfaction I have the honour to inform you of the safe arrival here, on the 4th of May, of the brigantine, S. Niccolo, Captain Alexander Scarneo. Besides, the crew are all in perfect health. " 4 As no quarantine is observed at this place, the crew had permission to leave the vessel whenever they pleased. As to the disposal of the cargo, we are in daily expectation of an order from his Highness the Viccroy. We here take our leave of the vessel, cargo, and crevr, and return to the island of Malta. 44 As the survivors of the original crew continued healthy in the lazaret of Malta, and as the dreaded ship no longer remained in the harbour, the deluded inhabitants began to congratulate themselves on their supposed happy escape. 44 But, on the 19th of April, a Maltese physician, Dr.Gravagna, being called to visit a child of the name of Borg in Strada S. Paolo, found it in a dying state, of what he then believed to be a typhui fever. He observed a carbuncle on its breast; but, as this was small, and as the family were subject to cutaneous disorders, the real nature of the disease was not suspected. The child had been ill five or six days. " On the 1st of May, the same physician was again called to see the mother of this child, whom he found affected with fever, accom.
panied by a painful tumour in the superior inguinal glands. On the 3d, she was delivered of a child of seven months, which died as soon as it came into the world. In the course of the same day, another tumour of an inflammatory nature was perceived in the glands of the other groin of the mother, and she died before the next momiog. 44 During the sickness of the mother, another child was attacked ?with fever, which, however, did not prove mortal. 44 The father of this unfortunate family, Salvator Borg, had not long to bewail the loss of his wife and infant, before he himself was threatened with a similar fate. On the morning of the 4th, he was attacked with fever, accompanied with glandular swellings in the axilla and groin. 4< Dr. Gravagna, being now no longer in doubt as to the nature of the disease, related every thing that had happened to the deputation of health.
On hearing the account, they immediately ordered that not only Borg's family, but every individual proved to have had the least communication with it, should be instantly removed to the lazaret; and this order was executed with the greatest care and industry." Without pursuing the disease further, it is sufficient to remark, that the general opinion at Malta was, that the plague could only be communicated by contact; but, in the instance quoted, not only no contact could be proved, but none was within the reach of probability. Innumerable other instances are produced in which the plague spread in a similar manner, and some in which the closest contact was unattended with any ill consequences. The proclamations, and their strict observance, are next transcribed, with satisfactory remarks: the history then continues? 44 In spite of these and many other rules and regulations, the disease continued to spread itself in every part of the city, attacking principally the poor, and those inhabiting small and dirty S23 houses. The veteran soldiers, too, who were placed at the doors of the infected houses, were frequently attacked. On the 18th, there were seven people attacked. On the 19th, three attacks and eight deaths; and on the 20th, eleven attacks and ten deaths, according to the reports." Whilst the gentleman to whose review we submitted the above article was preparing his remarks, we were favoured with the following communication, of which he has availed himself.

GENTLEMEN,
Having been honoured with a perusal in MS. of Dr. Calvert's Account of the Plague at Malta, I took the opportunity of introducing that gentleman, with his paper, to some persons high in office in this kingdom. Having also considered the subject very maturely, my opinions in writing were submitted to the same authorities. If they will be at all useful, or are thought worthy of your notice, they are quite at your service. I can have no intention to question the accuracy of Dr. Calvert on any incident related from his own knowledge, or even which, he found well authenticated during his residence at Malta ; but it should be remarked, that when the vessel which is supposed to have introduced the plague arrived at that island, the doctor was in Sicily. In the history of this vessel we are informed?
That two of the crew died during the voyage of a disease which the captain suspected to be the plague.
That, in consequence, he kept himself at a careful distance from such of the crew as he suspected; and gave information, on his arrival at Malta, of all that had happened. That, on his arrival, he was ordered to the quarantine island in the harbour, where he died of the plague.
That the quarantine was observed with as much severity as possible, and, there is no reason to doubt, with equal fidelity.
That the first subjects who were attacked were in a part of th?
town distant from the sea side, and ina a very close and dirtystreet.
That the greater part of that family died. That every precaution was taken to prevent intercourse, and the disease for a time seemed to cease, which was, of course, imputed to the cautions used.
That subsequently the disease appearing in various parts of tho town, but never spreading, excepting in the narrow and crowded streets, it was thought advisable to divide the town into districts, s s 2 by 304 Critical Analysis? by barriers, and to place a sentry at each barrier, in order to pre-??ent any dangerous communication between the different parts.
That, notwithstanding all these precautions, the plague broke out at various parts of the town, and whenever it began in a close or crowded street, it continued to spread.
That, in Dr. Calvert's opinion, it was always conveyed to every new place by the arrival of a person with the disease on him, or seized with it soon after his arrival.
That, on the approach of winter, or on some change of the atmosphere, the disease ceased.
That the ship returned with a fresh crew to the port from which if was supposed to have brought the plague, and, without any quarantine, the crew, which had not suffered in the-supposed in. fected vessel, were permitted to land all their cargo, which they did without injury to the inhabitants.
That almost all who were sent to the city lazaretto died.
That.few died who were received into the military hospital; and that the disease did not spread there.
That persons affected with other diseases soon found them con.
verted into the plague.
That one woman among the military, much addicted to drunken, ness, was seized with the plague, auddied; but that the disease did not spread among the soldiers.
That very few escaped of those who were sent to the civil pest house.
From the above history I should venture to draw the following conclusions:?
That if the men who died during the voyage had the plague, which is highly probable, there is no proof that they brought it from the place at which they received the clean bills.
If they really introduced the plague into Malta, neither certificates nor quarantines are any security; and it is certain that they returned from a port [MaltaJ which could not give them a clean certificate, to a port free from the plague, without any quarantine^ and without introducing the plague.
If the men had the plague during the voyage, it is not more remarkable than that part of the crew of a ship should be seized with mumps during a voyage from a port at which the disease did not exist. This is by no means uncommon ; but a much more frequent event is that a crew leaving a port in health shall be seized with influenza during their voyage. Thevenot, in his VoyageauLevant, gives a short history of an epidemic catarrh which reigned in Grand Cairo, with such severity, and so universally, that he does not scruple to consider it si contagieuse que se gagnoit faciiement par la communication d'halcine. The disease, he adds, extended itself so far, that afterwards, Avhen they were at Jerusalem, and at other places round about, it was found those places were afflicted at the same time, and even the corsairs who took them had it at that time.
Here a disease, the cause of which evidently only existed in the atmosphere, was pronounced contagious, merely on account of its universality Thucydides, who gives this character to the disease at Athens, describes it, in its beginning, precisely as an influenza. In its pro* gress it assumed all the forms of a garrison fever., with hospital gangrene.
From this I should conclude that the same constitution of the air as induced the plague in Malta, first introduced it into a crowded vessel; that in the latter the common men only were infected, because they only were crowded. But, that on their arrival at the lazaretto, the captain, having now changed the deck of his ship, on which he was exposed to a constant change of atmosphere, for an island within a confined harbour, so low as only just to rise above the water, was constantly breathing an unchanged atmosphere ; and that the great and sudden change from a free at. mosphere to the confined air in a flat island, in a good harbour, was sufficient to account for his greater susceptibility; and such is usually the case with fresh comers, who are the first seized with yellow fever. No one disputes that the quarantine was strictly observed; yet the plague first appeared at a distant part of the town, in a crowded neighbourhood, and a close street. The customary precautions were taken, and, it was supposed, with success; yet the plague afterwards appeared in various parts, in all of which it was supposed to be brought by different persons from the infected parts.
But why are we to look for such a cause, when we find that the first persons affected in the town could have had no intercourse with the harbour.
Those who were sick of other complaints found their diseases changed into the reigning epidemic, an observation as old as Thucydides, and constantly occurring with every severe influenza.
The question should, therefore, have been, whether these people, among the wealthier or better-regulated communities, communicated the disease?
There is not a single proof that they did ; and we are expressly told that the-female drunkard who was affected in the barracks never infected any other person.
That the persons employed to bury the dead on these occasions suffered, contrary to what happened in European houses, is easily explained. At Malta they fetched the dead from pestilential quarters of the town. Among the Europeans they are taken from houses in which solitary cases have occurred in healthy families.
All these questions are unnoticed by Dr. Calvert, as well as in the progress of the plague at Aleppo, as described by Dr. ttussel; yet these two accounts may be considered the only histories of the infectious march of a plague, containing matter sufficient to admit of satisfactory reasoning. They both induce me to believe that the Ing of the infection during the autumnal months, the business of the police should be to lessen the ravages of the plague during those months, without expecting its extinction till before the change of season. Instead, therefore, of confining every one to pestilential houses and districts, no one should be allowed to enter them; and proper encampments should be prepared for all those who chuse to leave them, which they should be encouraged to do by bringing their sick with them.
If the account given of the fever of Gibraltar in the last volume of the Medico-Chirurgical Transactions is examined, it will be found, in its infectious march, in many respects similar to that of the plague in Malta; and its introduction by a diseased subject, though by no means satisfactory, rests on better grounds than the introduction of the plague at Malta by the suspected vessel. Though this performance is intended only to assist the charitable designs of those who drew it up, it is well worth preserving as a medico-statistical record. As a specimen we have selected the following: